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Norfloxacin (Noroxin)
(nor- FLOX-ah-sin)
Pregnancy Category: C Chibroxin Ophthalmic Solution Noroxin Noroxin Ophthalmic Solution (Rx)

Classification: Fluoroquinolone anti-infective

See Also: See also Anti-Infectives and Fluoroquinolones .

Action/Kinetics: Active against gram-positive and gram-negative organisms by inhibiting bacterial DNA synthesis. Not effective against obligate anaerobes. Peak plasma levels: 1.4-1.6 mcg/mL after 1-2 hr following a dose of 400 mg and 2.5 mcg/mL 1-2 hr after a dose of 800 mg. t 1/2: 3-4.5 hr. Food decreases the absorption of norfloxacin. Approximately 30% excreted unchanged in the urine and 30% through the feces.

Uses: Systemic: Uncomplicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, P. vulgaris, Pseudomonas aeruginosa, Citrobacter freundii, Staphylococcus aureus, S. epidermidis, Enterococcus faecalis, Enterobacter aerogenes, S. saprophyticus and S. agalactiae. Complicated UTIs caused by Enterococcus faecalis, E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa or Serratia marcescens. Urethral gonorrhea and endocervical gonococcal infections due to penicillinase- or non-penicillinase-producing Neisseria gonorrhoeae. Prostatitis due to E. coli.
Ophthalmic: Superficial ocular infections involving the cornea or conjunctiva due to Staphylococcus, S. aureus, Streptococcus pneumoniae, E. coli, Haemophilus aegyptius, H. influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus species, Enterobacter aerogenes, Serratia marcescens, Pseudomonas aeruginosa and Vibrio species.

Contraindications: Hypersensitivity to nalidixic acid, cinoxacin, or norfloxacin. Lactation, infants, and children. Ophthalmic use for dendritic keratitis, vaccinia, varicella, mycobacterial infections of the eye, fungal disease of the eye, and use with steroid combinations after uncomplicated removal of a corneal foreign body.

Special Concerns: Use with caution in clients with a history of seizures and in impaired renal function. Geriatric clients eliminate norfloxacin more slowly.

Side Effects: See also Side Effects for Fluoroquinolones.
GI: N&V, diarrhea, abdominal pain or discomfort, dry/painful mouth, dyspepsia, flatulence, constipation, pseudomembranous colitis, stomatitis. CNS: Headache, dizziness, fatigue, malaise, drowsiness, depression, insomnia, confusion, psychoses. Hematologic: Decreased hematocrit, eosinophilia, leukopenia, neutropenia, either increased or decreased platelets. Dermatologic: Photosensitivity, rash, pruritus, exfoliative dermatitis, toxic epidermal necrolysis erythema, erythema multiforme, Stevens-Johnson syndrome. Other: Paresthesia, hypersensitivity, fever, visual disturbances, hearing loss, crystalluria, cylindruria, candiduria, myoclonus (rare), hepatitis, pancreatitis, arthralgia.

Following ophthalmic use: Conjunctival hyperemia, photophobia, chemosis, bitter taste in mouth.

Laboratory Test Alterations: AST, ALT, alkaline phosphatase, BUN, serum creatinine, and LDH.

Additional Drug Interactions: Nitrofurantoin antibacterial effect of norfloxacin.

How Supplied: Ophthalmic solution: 0.3%; Tablet: 400 mg

?Tablets Uncomplicated UTIs due to E. coli, K. pneumoniae or P. mirabilis.
400 mg q 12 hr for 3 days.
Uncomplicated UTIs due to other organisms.
400 mg q 12 hr for 7-10 days.
Complicated UTIs.
400 mg q 12 hr for 10-21 days. Maximum dose for UTIs should not exceed 800 mg/day.
Uncomplicated gonorrhea.
800 mg as a single dose.
Impaired renal function, with C CR equal to or less than 30 mL/min/1.73 m 2.
400 mg/day for 7-10 days.
Prostatis due to E. coli.
400 mg q 12 hr for 28 days.
?Ophthalmic Solution Acute infections.
Initially, 1-2 gtt q 15-30 min; then, reduce frequency as infection is controlled.
Moderate infections.
1-2 gtt 4-6 times/day.

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